Free USMLE step 3 sample questions and answer

Along with 25 free USMLE step 3 sample questions, in this practice test, we also introduce to you the USMLE step 3 exam format, to help you more understand about this examination.

USMLE step 3 exam format

Step 3 is a two-day examination. The first day of testing includes 256 multiple-choice items divided into 6 blocks of 42 to 43 items; 60 minutes are allotted for completion of each block of test items. Items with an associated pharmaceutical advertisement or scientific abstract are included in each of these multiple-choice blocks. There are approximately 7 hours in the test session on the first day, including 45 minutes of break time and a 5-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

There are approximately 9 hours in the test session on the second day. This day of testing includes a 5-minute optional tutorial followed by 198 multiple-choice items, divided into 6 blocks of 33 items; 45 minutes are allotted for completion of each block of test items. The second day also includes a 7-minute CCS tutorial. This is followed by 13 case simulations, each of which is allotted 10 or 20 minutes of maximum real time. A minimum of 45 minutes is available for break time. There is an optional survey at the end of the second day, which can be completed if time allows.

USMLE step 3 sample questions and answer

As we have introduced above, along with the USMLE step 3 exam format, in this practice test, we also present 25 USMLE step 3 sample questions and answers for the Step 3 of the USMLE.

Free USMLE step 3 sample questions and answer. Image: Shutter Stock

Take our free USMLE step 3 sample questions in this USMLE step 3 practice test will help you prepare for the Step 3 of the United States Medical Licensing Examination.

After completion of the answer choices for each question accurately, click the “Submit” button at the bottom of the page to see the results of your USMLE Step 3 practice test. Results of the practice test will help you evaluate the strengths and knowledge of you on this exam.

Free USMLE Step 3 Questions

A 62 year old male with a history of hypertension, diabetes, rheumatoid arthritis and prior mechanical aortic valve replacement, presents to the emergency department with fevers for 3 days. He denies any chest pains or shortness of breath. His medications include lisinopril, hydrochlorothiazide, aspirin, and coumadin. His temperature is 38.4 C, blood pressure is 160/60, heart rate 100, respirations 20, and oxygen saturation 99% on room air. Physical examination reveals normal lung sounds, a II/IV early diastolic decrescendo murmur at the left lower sternal border, and a very soft S1 heart sound. Laboratory studies reveal a white blood cell count of 15 thousand and an ESR of 110. A portion of his ECG is below. Which of the following is the most approtriate test to obtain at this time?

A. Coronary angiography

B. Transthoracic echocardiogram

C. Transesophageal echocardiogram

D. Cardiac magnetic resonence imaging

A 58 year old male with a history of diabetes, hypertension, and a renal transplant presents to the emergency department after being found unresponsive at home. His temperature is 37.3 C, blood pressure is 70/30, heart rate 120, respirations 24, and oxygen saturation 70% on room air. Physical examination reveals bilateral pulmonary rales, a S4 heart sound is present, and no murmurs could be auscultated. He is intubated for airway protection. ECG reveals sinus tachycardia with a left bundle branch block. A Swan-Ganz catheter is inserted and the values are below:
Right atrial pressure - 8 mmHg
Right ventricular pressure - 38/8 mmHg
Pulmonary artery pressure - 42/22 mmHg
Pulmonary capillary wedge pressure - 26 mmHg
Cardiac output - 4.0 L/min
Cardiac index - 2.0 L/min/BSA
Which of the following is best course of action?

A. Tissue plasminogen activator infusion (tPA)

B) Emergent cardiac catheterization

C) Echocardiography

D) Glycoprotein IIb/IIIa infusion

A 92 year old male with hypertension and gout presents to the emergency room with an episode of passing out while sitting at the table. He has felt generally weak for the past 4 days. He denies any chest pains, shortness of breath, or other complaints. His medications include metoprolol and celecoxib. His blood pressure is 115/65, heart rate 42, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds, a regular, bradycardic rhythm with varying intensities of the S1 heart sound, and intermittent large intermittent cannon A waves in the jugular venous pulsations. His laboratory studies are normal. His ECG is below. What is the appropriate treatment?

A. Observation

B) Discontinue metoprolol

C) Permanent pacemaker implantation

D) Defibrillator implantation

A 62 year old male with a history of mitral valve prolapse, rhematoid arhtritis, and colon cancer presents to the emergency room with increased dyspnea on exertion, lower extremity swelling, and fevers slowly worsening over the past month. His temperature is 38.0 C, blood pressure 95/65, heart rate 80, respirations 20, and oxygen saturation 92% on room air. Physical examination reveals normal breath sounds, a II/VI holosystolic murmur at the apex, and 1+ bilateral lower extremity pitting edema. Laboratory studies show a WBC count of 20 thousand and an ESR of 100. A transesophageal echocardiogram reveals an 8 mm mobile vegitation on the anterior leaflet of the mitral valve. Blood cultures grow Streptococcus bovis and he is treated appropriately with IV antibiotics for endocarditis. Which of the following further diagnostic work-up should be performed?

A. Coronary angiography

B. MRI of the brain

C. Pulmonary function testing

D. Colonoscopy

An 18 year old male with no significant past medical history passes out while running. He states that he was feeling a little dizzy prior to the event, but no chest pains or palpitations. His blood pressure is 115/85, heart rate 80, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds, a II/VI mid-systolic crescendo-decrescendo murmur is heard at the right upper sternal border which increases in intensity with Valsalva, an S4 heart sound is also present. Laboratory studies are normal. What is the most appropriate treatment at this time?

A. Start a diuretic

B. Implantation of a pacemaker

C. Implantation of a defibrillator

D. Observation

E. Atrial septal defect

A 74 year old male with diabetes mellitus and hypertension presents to the emergency department with chest pains. He is diagnosed with an anterior wall myocardial infarction and appropriate therapy is undertaken. Two months later he is seen by his cardiologist for dyspnea on exertion and lower extremity swelling. His ECG is below. What is his most likely diagnosis?

A. Pericarditis

B. Left ventricular aneurysm

C. Early repolarization

D. Cardiac tamponade

An 18 year old male with no significant past medical history presents to his primary care physician for a routine physical examination. He has no physical complaints. His blood pressure is 115/85, heart rate 80, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds, a V/VI holosystolic murmur with a thrill at the left lower sternal border and no change in intensity with inspiration, no gallops or extra heart sounds, and normal jugular venous pressures. His ECG and laboratory studies are normal. What is his most likely diagnosis?

A. Mitral regurgitation

B. Atrial septal defect

C. Tricuspid regurgitation

D. Ventricular septal defect

An 23 year old female with no significant past medical history presents to her primary care physician due to intermittent palpitations. She states that they occur randomly, can last for many minutes at a time, and make her dizzy. No syncope. Her blood pressure is 120/82, heart rate 72, and respirations 14. Physical examination is normal. Laboratory studies are normal including thyroid function testing. Her ECG is below. What is the most appropriate initial therapy?

A. Catheter ablation

B. Start verapamil

C. Start metoprolol

D. Start amiodarone

A 72 year old female with a history of diabetes mellitus presents to the emergency department with chest pains at rest intermittently for the past 4 hours. She has associated shortness of breath and diaphoresis. Her heart rate is 59, blood pressure 134/72, respiratory rate 20, and oxygen saturation 95% on room air. Physical examination reveals normal lung sounds and an S4 gallop. Her ECG reveals 1 mm ST segment depressions in leads V1 to V4. She is given aspirin immediately. Her troponin levels remain negative. She is currently chest pain free. Which of the following is the next appropriate step in her management?

A. Emergent cardiac catheterization

B. Intravenous glycoprotein IIb/IIIa inhibitor

C. Intravenous nitroglycerine drip

D. Intravenous heparin drip

A 21 year old college student without any prior past medical history comes to the emergency room with complaints of palpitations and dizziness. She states he was at a party recently and had been drinking alcohol heavily when she noted the symptoms. No chest pains or shortness of breath. Her blood pressure is 110/70, heart rate 160, respirations 20, and oxygen saturation 95% on room air. A portion of his ECG is below. An echocardiogram is normal. Which of the following is the most appropriate management at this time?

A. Emergent direct current cardioversion

B. Intravenous amiodarone

C. Intravenous diltiazem

D. Observation

A 71 year old female with a history of tobacco use, diabetes mellitus, rheumatoid arthritis, breast cancer is seen by her primary care physician for a routine follow-up visit. She has been feeling generally weak. She can only walk about 1/2 block before getting short of breath and dizzy. She denies chest pain. Her blood pressure is 90/60, heart rate 90, respirations 20, and she is afebrile. Her physical examination reveals normal breath sounds and no cardiac murmurs but heart sounds are distant. Her chest x-ray is below. What is her most likely diagnosis?

A. Pericardial effusion

B. Congestive heart failure

C. Pulmonary hypertension

D. Mitral valve stenosis

A 42 year old male with a history of hypertension has been experiencing dyspnea on exertion. He denies any chest pain. His blood pressure is 140/40, heart rate 90, and respirations 18. Physical examination reveals elevated jugular venous pressure, an early systolic ejection sound is heard. A III/IV early diastolic decrescendo murmur heard best at the right upper sternal border is present along with a I/IV diastolic rumble at the apex. Also noted is a II/VI systolic ejection murmur at the right upper sternal border. What other physical exam finding might you expect?
A#A. Pulsus bisferens
B. Pulsus alternans
C. Pulsus paradoxus
D. Pulses parvus et tardus

A 46 year old female with a history of alcohol abuse was brought to the emergency room for altered mental status. Her temperature is 37.0 C (98.6 F), blood pressure is 120/80, heart rate 70, respirations 16. Physical examination reveals a cachectic appearing female, normal breath sounds, and normal heart sounds without murmurs. In the emergency room she becomes completely unresponsive for 1 minute and her blood pressure decreases to 50/30. Her telemetry strip during the event is below as well as her 12 lead ECG afterwards. What is the best treatment at this time?

A. Intravenous saline

B. Intravenous procainamide

C. Intravenous calcium

D. Intravenous magnesium

An 48 year old male with a history of hypertension presents to the emergency room with chest pain. He is diaphoretic and short of breath. His temperature is 37.1 C, blood pressure 120/82, heart rate 82, and respirations 20. His physical examination is significant for an S4 heart sound. ECG reveals an inferior wall ST elevation myocardial infarction and appropriate treatment is undertaken. He is discharged home and was doing well. Two months later he develops a sharp chest pain worse with laying flat radiating to his left neck. He returns to his cardiologist and his temperature is 38.5 C, blood pressure 118/82, heart rate 80, and respirations 18. Physical examination is normal. ECG reveals ST segment elevation in leads I, II, III, aVF, aVL, and V1-V4 as well as PR depression in lead II. What is the best treatment at this time?

A. Intravenous heparin

B. Ibuprofen

C. Coronary angiogram

D. Prednisone

A 58 year old male with a history of hypertension and diabetes presents to the emergency room with chest pain at rest. He is afebrile, blood pressure is 110/70, heart rate 70, and respirations 18. Physical examination reveals normal lung sounds, normal jugular venous pressure, and an S4 heart sound. Laboratory studies are initially normal. His ECG is below. What complication is most commonly associated with this patient's diagnosis?

A. Acute mitral regurgitation

B. Left ventricular thrombus

C. Left ventricular aneurysm

D. Left ventricular rupture

A 26 year old female with no past medical history presents to her primary care office with a complaint of palpitations for the past few months. She states that they occur intermittently and are not associated with dizziness, syncope, or chest pains. Her blood pressure is 120/80, heart rate 80, and respirations 20. Physical examination reveals normal lung sounds, no murmurs, and a mid-systolic click that moves to early systole with standing from a squatting position. Her ECG is normal. Which of the following is associated with this cardiac disorder?

A. Marfan's syndrome

B. Congenital coronary anomalies

C. Sudden cardiac death

D. Ventricular tachycardia

A 67 year old male with a history of severe chronic obstructive pulmonary disease (COPD), hypertension, and congestive heart failure presents to the emergency room with increasing shortness of breath over the past week. He denies any chest pains or fevers. His temperature is 37.0 C, blood pressure 130/70, heart rate 120, respirations 24, and oxygen saturation 87% on room air. Physical examination reveals diffuse expiratory wheezing without rales, heart sounds are normal without murmurs and an irregularly irregular rhythm is noted. There is trace lower extremity pitting edema. Laboratory studies reveal a mildly elevated b-type natriuretic peptide and an elevated white blood cell count. His chest x-ray shows hyperexpanded lungs and no evidence of pulmonary edema. His ECG is below. What is the appropriate treatment for his heart rhythm disorder?

A. Propranolol

B. Verapamil

C. Amiodarone

D. No specific medication treatment

A 44 year old male with no significant past medical history presents to his primary care physician for a routine physical examination. He has no physical complaints. His blood pressure is 115/85, heart rate 80, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds and normal heart sounds. His ECG is normal. Laboratory studies reveal an total cholesterol of 220 mg/dL, LDL 145 mg/dL, HDL 40 mg/dL, and triglycerides of 145 mg/dL. What is the most appropriate treatment?

A 32 year old male with no significant past medical history presents to the emergency room with 3 hours of chest pain at rest. His blood pressure is 120/80, heart rate 80, and respirations 20. Physical examination is normal. Laboratory and a chest x-ray is normal. His ECG is below. Which of the following is the appropriate therapy?

A. Observation

B. Non-steroidal anti-inflammatory drugs

C. Corticosteroids

D. Emergent cardiac catheterization

A 55 year old male with a history of hypertension has the following fasting lipid profile:
Total cholesterol 240 mg/dL
LDL cholesterol 98 mg/dL
HDL cholesterol 35 mg/dL
Triglycerides 140 mg/dL
Which of the following is the most appropriate treatment?

A. Diet and lifestyle modifications

B. Start niacin

C. Start gemfibrozil

D. Start an HMG-CoA reductase inhibitor

E. No therapy is needed

A 42 year old female with no significant past medical history presents to the emergency department with hemoptysis of acute onset. She has noted recent dyspnea on exertion now to the point where she can only walk ½ blocks before having to rest. She denies chest pain. Her temperature is 37.0 C, blood pressure 110/60, heart rate 100, respirations 20, and oxygen saturation 95% on room air. Physical examination reveals normal lung sounds, an irregularly irregular rhythm, a II/IV early diastolic murmur heard best at the cardiac apex, and 1+ lower extremity pitting edema. Laboratory studies are normal. ECG shows sinus tachycardia and left atrial enlargement. Which of the following is causing this patient’s symptoms?

A. Mitral valve stenosis

B. Mitral valve prolapse

C. Mitral valve regurgitation

D. Aortic valve stenosis

E. Aortic valve regurgitation

A 45 year old male with a history of hypertension and dyslipidemia presents to the emergency department with substernal chest pressure for 1 hour. The pain occurred at rest, is 10/10 in severity and is associated with shortness of breath. His temperature is 37.1 C, blood pressure 80/50, heart rate 90, and respirations 20. His laboratory studies are normal. His ECG is below. What is the appropriate initial management?

A. Intravenous beta-blockers

B. Sublingual nitroglycerine

C Intravenous heparin

D. Intravenous dobutamine

A 35 year old male with no past medical history presents with increasing shortness of breath and dyspnea on exertion and lower extremity edema increasing over the past month. His temperature is 37.0, blood pressure 90/60, heart rate 100, respirations 20, and oxygen saturation 95% on room air. Physical examination reveals decreased breath sounds at the left base without wheezing, elevated jugular venous pressure markedly worse with inspiration, a regular rhythm with an S4 heart sound and 2+ lower extremity pitting edema. Laboratory studies are normal. Cardiac biopsy revealed green birefringence with Congo red staining. Genetic testing reveals a mutation in the transthyretin gene. Which of the following is the correct diagnosis?

A. Constrictive pericarditis

B. Restrictive cardiomyopathy

C. Dilated cardiomyopathy

D. Hypertrophic obstructive cardiomyopathy

A 19 year old cross country runner is referred to a cardiologist for an abnormal ECG. He states that overall he feels well and denies any chest pains or shortness of breath. He also denies syncope or palpitations. His ECG is below. Which of the following is the most likely diagnosis?

A. Brugada syndrome

B. Wolff-Parkinson-White syndrome

C. Pericarditis

D. Early repolarization

A 42 year old female presents to with increasing dyspnea on exertion and lower extremity edema. She denies chest pains. Her temperature is 37.0, blood pressure 150/90, heart rate 100, respirations 20, and oxygen saturation 92% on room air. Physical examination reveals normal breath sounds, elevated jugular venous pressure, a III/VI holosystolic murmur at the apex occurring after a mid-systolic click, an S3 heart sound, and 1+ pitting lower extremity edema. Which of the following is the best treatment at this time?